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目的评价上海市南汇区“脑卒中高危人群筛检与重点干预”一级预防策略的成本效果和效益。方法 1999年开始 ,在上海市南汇区全区近 70万干预人群中筛选 35岁及以上、至少具有一种脑卒中危险因素暴露者 ,进行脑血管血液动力学指标 (CVHI)检测 ,对 CVHI积分值≥ 70分的人群针对危险因素暴露情况给予一般干预 ,对积分值 <70分的个体 ,在一般干预的基础上服用脑安胶囊。按照项目所需的实际投入和减少脑卒中发病所需的医疗费用计算净成本 ,根据净成本和干预效果计算效果和效益指标。结果 3年的干预需要投入粗成本 3116 86 32元 ,干预 3年后因减少患者节省的医疗费用为 30 70 912 5元 ,全区 3年实施干预策略需投入净成本 4 5 95 0 7元 ,产生的主要健康效果为减少脑卒中发病10 11例 ,增加健康生命年 5 6 87年 ,增加潜在劳动年 995年 ,每减少 1例脑卒中发生需要投入净成本 4 17元 ,效益成本比为 12 .6。敏感性分析提示 ,在假设医疗费用上涨 5 %时 ,净成本减低 5 0 % ,假设劳动力价格上涨 10 % ,效益成本比为10 .1。结论“脑卒中高危险人群筛检与重点干预”是一项成本 -效果良好的一级预防策略。
Objective To evaluate the cost effectiveness and benefit of the primary prevention strategy of “high risk population of stroke in stroke screening and key intervention” in Nanhui District, Shanghai. Methods From 1999, nearly 700,000 interventional population in Nanhui District of Shanghai were screened for at least one age-35-year-old with at least one exposure to stroke risk factors for cerebrovascular hemodynamic variables (CVHI). CVHI scores People with a score of 70 or more were given general interventions for exposing to risk factors. For individuals with an overall score of <70, patients were given Na On Capsule on a regular basis. Calculate the net cost according to the actual investment required by the project and the medical expenses needed to reduce the incidence of stroke, and calculate the effect and benefit indicators according to the net cost and the intervention effect. Results The cost of 3-year intervention was 3,166,886 yuan. The medical costs saved after 3 years of intervention were 30,709,125 yuan. The 3-year implementation of intervention strategy required a net cost of 4,595,07 yuan. The main health effects to reduce the incidence of stroke in 1011 cases, an increase of 566 87 years of healthy life, an increase of potential labor years 995, for each reduction in the incidence of stroke need to invest a net cost of 417 yuan, the cost-benefit ratio of 12 .6. Sensitivity analysis suggests that the net cost is reduced by 50% assuming an increase of 5% in medical costs, assuming a 10% increase in labor costs and a cost-benefit ratio of 10.1. Conclusions “Screening and Key Interventions for High Risk Populations in Stroke” is a cost-effective primary prevention strategy.